Aerobic and Resistance Exercise Improves Shoulder Function in Women Who Are Overweight or Obese and Have Breast Cancer: A Randomized Controlled Trial

Abstract

Abtract Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2–20.7°], external rotation at 0° = 23.4° [95% CI = 31.1–12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9–26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.

Desempenho funcional do membro superior após cirurgia para câncer de mama de mulheres no menacme

“…Na avaliação inicial, os movimentos de abdução, flexão e rotação lateral foram os mais comprometidos, associado ao elevado escore do DASH, indicam que prejuízo da ADM interfere na realização das atividades de vida diária [7,10]. Thomas-Maclean et al [17], considerando mulheres acima de 18 anos, avaliaram a ADM, dor, linfedema e correlacionaram essas variáveis com o DASH após o período de 6 e 12 meses depois da cirurgia e observaram uma correlação significativa da limitação da ADM e dor com deficiência no desempenho funcional.…”

“…Entretanto, a maioria dos estudos consideram mulheres de diferentes idades em suas amostras, envolvendo tanto mais jovens quanto de idade avançada. Sweeney et al [10] randomizaram 100 mulheres em 16 semanas de exercícios aeróbicos, resistidos, supervisionados e progressivos 3 vezes por semana e outro grupo em cuidados habituais. O grupo intervenção demonstrou melhora superior e significativa na ADM, DASH e força isométrica.…”

“…O procedimento cirúrgico pode gerar complicações tanto imediatas quanto tardias, como infecções locais, deiscência, necrose cutânea, seroma, retrações cicatriciais, alterações funcionais, lesões nervosas, distúrbios da sensibilidade, alteração da amplitude de movimento (ADM) do ombro, dor, síndrome da rede axilar e linfedema [3][4][5][6][7][8]. Isso pode afetar negativamente no desempenho funcional do membro superior homolateral à cirurgia, levando a limitações em sua autonomia, como em realizar as atividades de vida diária (AVDs) que impactam no autocuidado, bem como na realização de atividades de vestuário e higiene, atividades laborais, domésticas, de lazer e também na função emocional [7][8][9][10].…”

A randomized study to prevent lymphedema in women treated for breast cancer: CALGB 70305 (Alliance)

“…Exercise has benefits, such as restoring strength, function, and ROM, improving overall well‐being, 30,31 and maintaining or developing muscle tone that helps mobilize fluid from the limb with or without compression garments, 32,33 and its promise as a means of lymphedema risk‐reduction is emerging. Recent studies of breast cancer patients that incorporate aerobic and/or resistance exercise, as well as regular compression garment use, suggest that these activities may reduce the incidence and severity of lymphedema, improve ROM and improve QOL 34‐36 …”

Current Landscape: The Mechanism and Therapeutic Impact of Obesity for Breast Cancer

“…reported that a 16-week of supervised aerobic and resistance exercise interventions could decrease the 10-year risk of cardiovascular disease in early BC women who were overweight or obese ( 158 ). In the study of Sweeney et al., a 16-week exercise significantly promoted the shoulder function in overweight or obese women after BC treatment ( 159 ).…”